Guidance and responses were provided based on information known on 6/25/2020 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and NE DHHS guidance for updates. COVID-19 and LTC June 25, 2020
Questions and Answer Session Use the QA box in the webinar platform to type a question. Questions will be read aloud by the moderator If your question is not answered during the webinar, please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs A transcript of the discussion will be made available on the ICAP website https://icap.nebraskamed.com/coronavirus/ https://icap.nebraskamed.com/covid-19-webinars/ Panelists today are: Dr. Salman Ashraf, MBBS salman.ashraf@unmc.edu Kate Tyner, RN, BSN, CIC ltyner@nebraskamed.com Margaret Drake, MT(ASCP),CIC Margaret.Drake@Nebraska.gov
Map showing Counties Categorized by Days Last Tested Positive Cases Updated: 6/25/2020 8:00AM CST Source: Unofficial Counts Compiled by Nebraska ICAP based on date reported by facilities; Actual Numbers may vary slightly
Testing Considerations
Test Responsibly • PPE for tester • Full COVID-19 PPE • Respirator must seal-check • This video shows the proper way to do the N95 seal check https://www.youtube.com/watch?v=pGXiUyAoEd8 • Eye protection • Manage the residents • Consider appointments, not lines (even with social distancing and masks) • Manage the specimens • Plan for specimen pick-up or delivery to lab • How and where will specimens be stored? • Who is accountable for packaging?
Prepare For Results • There may be positive results in either staff, residents, or both • Staffing Plans • Containment plan is ready (Red and Yellow) • PPE staged • Staff are competent • Pull the plan https://icap.nebraskamed.com/wp- content/uploads/sites/2/2020/04/Actions-needed-to-be- taken-upon-identification-of-a-COVID-19-case.pdf
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2020/04/Actions-needed- to-be-taken-upon-identification-of-a-COVID-19-case.pdf
Popular Questions at ICAP this week…
Image: Pixabay Should we be re-using surgical/ procedure style masks for several shifts?
Limit use of procedure/surgical masks to 1 shift. Safe Extended Mask Use Requires: • Meticulous adherence to hand hygiene • Proper mask use and hygiene including wearing the mask as directed to cover the mouth and nose and • Strict avoidance of manipulation/touching the mask or eye protection to reduce the risk of contamination and self-inoculation https://www.nebraskamed.com/sites/default/files/documents/covid- 19/COVID-Extended-Use-Reuse-of-PPE-and-N95.pdf?date03212020
https://icap.nebraskamed.com/covid-19-resources-ppe/
Type of Looks like… Action Respirator Use for Airborne KN95 precautions, part of COVID- 19 PPE. Do not send for disinfection. Discard after use. Only appropriate for airborne precautions if wearer can get a seal check. Use for Droplet Precautions, KN90 similar to how a surgical or procedure mask can be worn. Do not send for disinfection. Discard after use. Do not use in healthcare. Respirator with exhalation valve
Can I extend the use of a Green respirator between gray zone and green zone? Image: Pixabay
What does CDC say on this? • Extended use refers to the practice of wearing the same N95 respirator for repeated close contact encounters with several different patients, without removing the respirator between patient encounters. • Extended use is well suited to situations wherein multiple patients with the same infectious disease diagnosis, whose care requires use of a respirator, are cohorted (e.g., housed on the same hospital unit). https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators- strategy/index.html
Remember that cohorting staff and residents is still an essential control strategy https://icap.nebraskamed.com/wp- content/uploads/sites/2/2020/04/Cohorting-Plan-for-LTCF-4.17.20.pdf
So can I extend the use of the respirator b/w zones? • It is better to work from lowest risk zone to highest (e.g., therapy practitioners or providers). • If you must work between zones, then a face shield should be worn to protect the N95 • Surgical masks + N95 are difficult to breathe through • Surgical masks + N95 burns an extra PPE item • Face shield should be cleaned between zones This poster shows cleaning the face shield after terminal doffing https://med.emory.edu/departments/medicine/divisions/infec tious-diseases/serious-communicable-diseases- program/pdf/v12-terminal-off-ace-reusable-gown-outside- room.pdf
Link Here
Opening for visitation There are facilities in Nebraska where visitation will be very appropriate • Many counties have not had cases in the past 14 days • Prioritize facilitation of visits for resident with highest need for visitors (e.g., significant decline) • Even in counties still seeing cases, compassionate care visits should be considered • Outdoor visitation should be considered • Position chairs 10 feet apart • Visiting booths appear promising • Set visits by appointment
Gray Zone and Reopening • Quarantine (14 days) for new admissions is included in both Phase 1 and Phase 2 • Phase 3 language • Plan to manage new admissions and readmissions who have an unknown COVID-19 status. • Plan to manage residents who routinely attend outside medically necessary appointments (e.g., dialysis). • Observe and monitor for 14 days upon return. (following medically necessary trips) http://dhhs.ne.gov/licensure/Documents/LTCCOVID19PhasingGuida nce.pdf
Gray Zone and Reopening • Consider quarantine may still be necessary for admissions from “hot - spots” • Many hospitals are opening visitation, so risks may be different in acute care vs. LTC • Cohorting staff to a single unit or hallway will remain important.
Best Practices in Bathing COVID- 19 and the ‘new normal’
Here is some practical guidance for bathing residents: • Asymptomatic, non-exposed residents may use the bath house. Mask these residents for transfer to the bath house/ tub room. • Symptomatic, COVID -19 + should have baths in their room • Transitional Zone/ Grey Zone residents should have baths in their room • Yellow Zone/ COVID-19 exposed/quarantine residents should have baths in their room • Consider scheduling long-term gray zone or any yellow zone residents at the end of the bath schedule (e.g.,wound care and dialysis)
175 NAC 12 12-007.04D1 for windowless toilets, baths, laundry HSP at least 10 ACH
Guideline Notes Staff member should don Because the resident will be removing their mask in the tub, it full set of clean PPE is necessary to mitigate all risks Ensure mask is placed on a clean Transfer the resident to and surface for reuse after the bath. from the spa with a mask on Cloth mask worn correctly is Alternatively, have a clean mask acceptable for the resident to wear after the bath Do not take a resident from a Spa must be within the zone green zone to a spa in i.e. the the resident resides in yellow zone. Also don’t take a resident from a yellow zone to a spa in the green zone Prepare the resident as To avoid having the resident’s Alternatively, place clothing into worn clothing placed on counters much as possible in their a laundry hamper/ bag as soon or other surfaces, transfer them room as it’s removed in a robe Follow the tub manufacturer’s guidance on If able to use other products use products that can be used in a disposable container to take Do not share products between the tub only the amount required into residents the spa room
Guideline Notes Declutter the room Make shelves and other surfaces easy to disinfect by removing all objects from them. If needed, items can be placed in containers with lids Any special ointments/ creams/ Do not share products between lotions should be kept in a residents locked cabinet Disinfect after use and allow Depending on air exchanges in Make sure staff understand how time between residents the spa, let the room rest the room is to be disinfected between residents. including what the disinfectant contact time is, and how to apply it Follow the tub manufacturer’s No exceptions instructions for tub disinfection between every resident Do not bring towel racks or carts Only take the towels that will be After the bath, all laundry into the spa room required for the resident into the including towels should be room bagged and sent to the laundry Waste Contain and remove waste Waste can be managed according between residents to standard procedures
Infection Prevention and Control Office Hours Monday – Friday 7:30 AM – 9:30 AM Central Time 2:00 PM -4:00 PM Central Time Call 402-552-2881
Questions and Answer Session Use the QA box in the webinar platform to type a question. Questions will be read aloud by the moderator, in the order they are received A transcript of the discussion will be made available on the ICAP website Panelists: Dr. Salman Ashraf, MBBS Kate Tyner, RN, BSN, CIC Margaret Drake, MT(ASCP),CIC Moderated by Mounica Soma, MHA Supported by Sue Beach https://icap.nebraskamed.com/resources /
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